Obstetric Complications and Psychological Well-Being: Experiences of Bangladeshi Women during Pregnancy and Childbirth

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INTRODUCTION

While childbirth is a positive experience for many women, it can be a traumatic one for others (1). Studies examining childbirth experiences of women have predominantly focused on various aspects of labour pain (2-4), control in decision-making in relation to delivery procedures, and satisfaction with overall delivery circumstances, including satisfaction with services received during labour (5-9). A few studies have examined the impact of pregnancy and childbirth experiences of women on psychological well-being, particularly their risks of postnatal depression--a major public-health problem worldwide.

Women in developing countries experience postnatal depression at rates that are comparable with or higher than those in developed countries (10). One-quarter of Asian women suffer from depression after childbirth. Surveys have found a 23% prevalence of postnatal depression in India (11), 28% in Pakistan (12), and 22% in Bangladesh (13). While the aetiology of postnatal depression is complex and multifaceted, the psychosocial factors have been identified as strong predictors for postnatal depression globally. Additionally, obstetric complications and delivery circumstances can be significant stressors for women and have been postulated as risk factors for postnatal depression. However, findings from the large number of studies examining the association between obstetric complications and postnatal depression are ambiguous (14-19).

Although some studies have demonstrated significantly higher levels of postnatal depression among women who experienced obstetric complications (14-16), others have failed to prove such links (17-19). For example, a prospective study on 490 women in New South Wales, Australia, did not find any significant association between complications during pregnancy and labour and postnatal depression (17). Another prospective study in France found a link between severe antepartum complications and increased severity of postnatal depression at six weeks postpartum but no such links could be found for complications during labour or delivery (18). Similar results have been reported from Manchester, England (19). All the three studies used medical definitions and diagnosis of obstetric complications, such as prolonged labour, eclampsia, antepartum haemorrhage, gestational diabetes, third-degree tear, etc. and ignored the women's self-reported personal experiences of childbirth.

Evidence suggests that pregnancy and childbirth experiences impact on the psychological state of women in the postpartum period (7). A prospective study on 825 women in southeast England found that measures of feelings of discomfort during pregnancy and childbirth were significantly associated with low psychological well-being in the postpartum period. Their subjective experience of childbirth appeared to have a greater impact on psychological state than other more objective aspects of childbirth, such as instrumentation or clinical interventions during delivery, e.g. episiotomies, enemas, and forceps deliveries.

We found no published literature in Bangladesh that directly examined the childbirth experiences of women and their psychological status in the postpartum period. However, the little that has been reported looked at issues, such as how women distinguished between normal and complicated birth, what elements are required to achieve a normal birth, and the various sociocultural aspects of childbirth (20). This ethnographic study on 100 rural women found that Bangladeshi women recognized the need to have both physical strength (shoriler shakti) and mental courage (moner shahosh) to survive the childbirth experience, indicating the psychological aspects of childbirth (20). The present study aimed to (a) describe the pregnancy and childbirth experiences among women in Bangladesh during normal childbirth or obstetric complications and (b) examine the relationship between these experiences and their psychological well-being during the postpartum period. …

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